Provider Demographics
NPI:1821298712
Name:SAMARITANS-AT-LAST LLC
Entity Type:Organization
Organization Name:SAMARITANS-AT-LAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MENYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-566-1361
Mailing Address - Street 1:1055 WESTLAKES DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-2410
Mailing Address - Country:US
Mailing Address - Phone:610-517-5560
Mailing Address - Fax:610-500-5223
Practice Address - Street 1:1055 WESTLAKES DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-2410
Practice Address - Country:US
Practice Address - Phone:610-566-1361
Practice Address - Fax:610-500-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA19993601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032084360001Medicaid
PA1022148690001Medicaid